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There are currently five
statin drugs on the market in the United
States: lovastatin, simvastatin, pravastatin, fluvastatin, and atorvastatin
(cerivastatin was withdrawn from the market by the manufacturer in August 2001). The major effect of the statins is to lower LDL-cholesterol
levels, and they lower LDL-cholesterol more than other types of drugs. Statins
inhibit an enzyme, HMG- CoA reductase, that controls the rate of cholesterol
production in the body. These drugs lower cholesterol by slowing down the
production of cholesterol and by increasing the liver's ability to remove the
LDL-cholesterol already in the blood. Statins were used to lower cholesterol
levels in the 4S, CARE, and LIPID studies. The large reductions in total and
LDL-cholesterol produced by these drugs resulted in large reductions in heart
attacks and heart disease deaths. Thanks to their track record in these studies
and their ability to lower LDL-cholesterol, statins have become the drugs most
often prescribed when a person with heart disease needs a cholesterol- lowering
medicine.
Studies using statins have reported 20 to 60 percent lower
LDL-cholesterol levels in patients on these drugs. Statins also reduce elevated
triglyceride levels and produce a modest increase in
HDL-cholesterol.
The statins are usually given in a single dose at the evening meal
or at bedtime. It is important that these medications be given in the evening
to take advantage of the fact that the body makes more cholesterol at night
than during the day.
You should begin to see results from the statins after several
weeks, with a maximum effect in 4 to 6 weeks. After about 6 to 8 weeks, your
doctor can do the first check of your LDL-cholesterol while on the medication.
A second measurement of your LDL-cholesterol level will have to be averaged
with the first for your doctor to decide whether your dose of medicine should
be changed to help you meet your goal.
The statins are well tolerated by most patients, and serious side
effects are rare. A few patients will experience an upset stomach, gas,
constipation, and abdominal pain or cramps. These symptoms usually are mild to
moderate in severity and generally go away as your body adjusts. Rarely a
patient will develop abnormalities in blood tests of the liver. Also rare is
the side effect of muscle problems. The symptoms are muscle soreness, pain, and
weakness. If this happens, or you have brown urine, contact your doctor right
away to get blood tests for possible muscle problems.
From the
National Heart, Lung, and Blood Institute of the NIH
Undated webpage
www.nhlbi.nih.gov/chd/meds1.htm
Also see
benefits of cholesterol lowering
cholesterol, diabetes, and the statins
high blood cholesterol
keeping cholesterol under control
modifying fat intake to minimize cardiovascular risk
Pharmacologic Lipid-Lowering Therapy in Type 2 Diabetes Mellitus: Background Paper for the American College of Physicians at the Annals of Internal Medicine
SUMMARIES FOR PATIENTS:
Control of Lipids in Patients with Type 2 Diabetes: Recommendations from the American College of Physicians
at the Annals of Internal Medicine
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